Dupuytren’s contracture (also known as Dupuytren’s disease), is a chronic disease that affects the tendons of the hand, so that there is a progressive thickening of the tissue located under the palm of the hand.
This thickening of the tendons prevents the correct flexion of the fingers and the affected palmar area, causing the retraction of the palm of the hand and with it the progressive, fixed and involuntary flexion of the fingers towards the palm of the hand, which ends up limiting to a great extent the performance of usual tasks and activities, thus affecting the quality of life of the patient.
Symptoms and diagnosis of Dupuytren’s contracture
Dupuytren’s contracture is a disease that progresses slowly over the years. Its symptoms usually develop painlessly, the main signs to detect it being the mobility problems it causes in the hand, as well as the deformations it causes, which are more palpable and visible the more advanced the disease is.
The first symptom to appear is the appearance of a hard nodule, similar to a callus, in the area of the folds of the palm of the hand, which is annoying, but does not hurt.
As the disease progresses, the protrusions are more noticeable and the thickened tissue that will later cause the joint to retract becomes more firmly perceived.
In its more advanced stages, these thickenings or “cords” of tissue that have formed under the skin of the palm can extend to the fingers, causing the fingers to begin to flex involuntarily. When the disease reaches this point, it is necessary to resort to surgery to free the joints and improve the quality of life of the patient.
In most cases, it usually begins by affecting the ring finger, followed by the little finger, and can also affect the middle finger, and only rarely does it affect the index finger and thumb. Dupuytren’s contracture can occur in both hands, although it is usually more severe in one of them.
The diagnosis of Dupuytren’s contracture by the specialist is usually simple, since in most cases a physical examination of the appearance and touch of the hands is enough to determine if a patient suffers from it. In making the diagnosis it is common for the patient to be asked to check whether he can place the open hand on a table or flat surface, or whether he can fully stretch the fingers.
Causes and prevalence of Dupuytren’s contracture
The cause of Dupuytren’s contracture remains unknown, although it could be associated with certain biochemical factors within the affected tissue. However, the risk factors that patients with this disease present are known, which is useful to detect and treat it early. These risk factors are the following:
- Age: it is more frequent in those over 40-50 years old.
- Sex: appears more frequently in men than in women, and they are more likely to suffer more severe contractures.
- Ancestry: it is more frequent in people of northern European descent
- Family history: Dupuytren’s contracture is often hereditary, those with a family history are more likely to suffer from it as well.
- Smoking and alcoholism: in addition to being generally harmful to health, both are associated with a higher risk of Dupuytren’s contracture.
- Diabetes: those with diabetes are also at higher risk of Dupuytren’s contracture.
Dupuytren’s contracture treatments
Currently there are various treatment options for Dupuytren’s contracture, which are very effective, with good and fast rehabilitation for the patient. The traumatologist specializing in Dupuytren’s contracture will evaluate the patient’s clinical picture and determine the best treatment, which usually depends largely on how advanced the disease is:
- In the earliest stages it is possible to perform physiotherapy treatments to slow the progression of Dupuytren’s contracture, but it is not possible to stop its progression permanently or to cure it completely.
- Needle treatment: used when mild symptoms appear. It consists of the use of needles to separate the thickenings that have developed in the palm of the hand.
- Surgery: surgical treatment is used in those patients in whom the disease is in an advanced state, when persistent pain appears despite other treatments or begins to affect the function and mobility of the hand. Through surgery, the tissue of the palm affected by the disease is removed.
In cases where it is necessary to perform surgery, it can be performed in a minimally invasive way or in an open way:
- Minimally invasive surgery: it is performed by hand and wrist arthroscopy, so that the incisions made are very small (less than 5mm), and it carries multiple advantages over open surgery: lower risk of infections, smaller scars (almost imperceptible), faster recovery and rehabilitation… For all these reasons, it is the option that is most used when it is necessary to resort to surgery, whenever possible.
- Open surgery: although minimally invasive arthroscopic surgery is usually preferable, in some of the more severe cases it may be necessary to perform open surgery to remove the thickened tissue and free the joint.
After surgery, physiotherapy treatments are performed to restore functionality to the hand, so that it gains strength and mobility, as well as helping to keep both the skin and the scars in the best possible condition.
Finally, it must be taken into account that Dupuytren’s contracture is a chronic disease, so that even after recovering hand mobility after surgery, there is still the possibility that symptoms will reappear over the course of the years.
Treatment of Dupuytren’s contracture at Vithas Xanit Internacional
If you are looking for a specialist in Dupuytren’s contracture, at Vithas Xanit Internacional we put the best specialists at your disposal, who, together with the latest techniques and technology, allow us to offer you the best possible results in our treatments. Contact us for more information or make an appointment.